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#WhyHVO – Improving Quality in the Delivery of Health Care Services

June 27th, 2019 / by Beth MacNairn

Quality should not be the purview of the elite or an aspiration for some distant future; it should be the DNA of all health systems.”

-Lancet Global Health Commission

Quality of care is essential to achieving universal health coverage (UHC) and the UN Sustainable Development Goals. As noted in several key reports on universal health coverage, including the Lancet Global Health Commission, access to health care services alone will not improve health outcomes.

In fact, poor quality care is “now a bigger barrier to reducing mortality than insufficient access.” Public trust in health systems, particularly around patient safety, erodes when the quality of care is poor, undermining global health security and contributing to human suffering. Suboptimal health care also exacts economic and social costs, leading to long-term disability, impairment and lost productivity equaling trillions of dollars each year, according to the reports.

But, how is ‘quality health care’ defined? According to the World Health Organization, quality care is “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred.”

We know that evidence-based policies, reliable supply chains, strong disease surveillance, adequate health facilities, and effective referral systems are all vitally important to the delivery of quality health care. However, without a trained and motivated health workforce, there is no health. This is the “universal truth” of the WHO’s groundbreaking 2013 report on the human resources for health needed to achieve universal health coverage. In the 2016 Working for health and growth: investing in the health workforce, the WHO High-Level Commission on Health Employment and Economic Growth highlights the essential role of health workers, noting, “Health workers are the cornerstone of a resilient health system.”

Building Health Workforce Capacity

HVO is expert in building health workforce capacity through teaching, training and professional mentorship. By helping to improve health worker performance, we address the critical human resource element integral to all health systems. Here are just a few examples of the ways in which HVO volunteers and our local partners work together to improve quality of care delivered by health workers:

Positioning for Life
In the neonatal intensive care unit (NICU) of HVO’s collaborating institution in Bhutan, the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), a small step supported improvement in the quality of care for preterm infants. Kathy Clark, PT, MS, MPT, a pediatric physical therapist volunteer, noted a lack of knowledge on the proper positioning of preterm infants. Clark used locally available materials to develop a bedroll, and trained the NICU staff on how to properly position infants with the bedroll. The staff quickly adopted this protocol and began making their own bedrolls. The result was an increase in the safety and effectiveness of care provided to infants in the NICU. As Ms. Clark noted, “Their effort resulted in improved positioning of premature babies that will positively affect their motor and sensory development, their ability to self-calm, and their respiratory status. Proper positioning will minimize skeletal deformities and muscle imbalances. It was a small but potentially profound change in behaviors.

“Not only was the fee prohibitive for hand reconstruction after injuries, but the waiting line to get into the OR was filled with higher priority cases, such as fractures of the long arm and leg bones. Most hand injuries were left untreated,” he explained in a 2018 article in the American Academy of Orthopaedic Surgeons’ AAOS Now magazine.

After watching repairable injuries go untreated because the costs associated with general anesthesia and an operating room were too great, or because the health facility had too few operating rooms and none was available in time, Dr. Lalonde decided to focus on making wide-awake hand surgery, performed only with local anesthesia, to resource-limited countries. Working alongside his colleagues at HVO’s site at Komfo Anokye Teaching Hospital in Kumasi, Ghana, Dr. Lalonde successfully introduced wide- awake hand surgery at that institution, enabling local providers to deliver desperately needed care in a manner that is more efficient – both in terms of time and cost. As Dr. Lalonde noted in AAOS Now, this increase in quality “has made reconstructive hand surgery more affordable and accessible for many people in Kumasi.”

As these two stories illustrate, HVO’s vision of a world where all people have access to high quality health care delivered by local health professionals is only possible when we focus on training the people who deliver care – health care providers. Working together, we can ensure that all people have access to care that is effective, safe, people-centered, timely, equitable, integrated and efficient.